[Reconstruction strategy in chest wall defect relating to the localization of the lost substances: retrospective study of 18 patients].
OBJECTIVE: To evaluate an original algorithm in function of the chest wall defect localization after large surgery for cancer including more than 3 ribs. PATIENTS AND METHODS: Our retrospective study on 18 patients (10 women, 8 men), operated by the senior author, showed 8 pathological tumor localization in the central chest region, 7 in the lateral region and 3 borderline localizations. For central localizations, when the sternum was resected, the reconstruction was realized with a Gore-tex mesh in depth, metal hooks (staples) and Marlex mesh under the musculocutaneous superficial coverage flap. Lateral localizations was done by a Gore-tex mesh covered by the musculocutaneous flap; the borderline localizations were covered by a Marlex mesh and superficial musculocutaneous flap. The superficial coverage flaps were performed by latissimus dorsi flaps in 16 cases and transversus rectus abdominis flap in 2 cases. RESULTS: All the patients were extubated and breathed spontaneously in the postoperative period. Two deaths and one infection were to regret at distance. No flap was lost. CONCLUSION: The algorithm of reconstruction according to the location of the defect allows a simplification of the indications.